“Hospital Within A Hospital” Possible Solution for Healthcare Merger Concerns

by Gabe Bullard on July 21, 2011

Catholic hospitals, like most religious healthcare institutions, follow a set of medical ethics based in religion. It’s probably unnoticeable for a patient with a broken leg, but for others, the difference is clear. There’s a gap between what the Catholic church deems acceptable and what the law allows in reproductive services. That gap includes abortion, stem cell research, vasectomies, treatments for infertility, emergency contraception for rape victims and birth control counseling.

It’s a gap that many are concerned will be created when University of Louisville Hospital merges with Jewish Hospital and St. Mary’s Healthcare and a division of Catholic Health Initiatives.

“It’s scary just in general not having health insurance, and to think that I would have to rely on a hospital that’s under some religious directive, to do that, I’d probably go somewhere else if I could,” says Angela Wallace.

Wallace was so upset when she heard that U of L Hospital would accept Catholic directives in the merger that she and her friends put together a petition to ensure services are protected. Several hundred people have signed the list, and it’ll be published as an ad in the Courier-Journal this weekend.

“Religious doctrine shouldn’t be part of healthcare for our community,” says Wallace. “If you’re going to serve the public in a healthcare capacity, it needs to be about the humanity you provide, not about religious ideology.”

But U of L says Wallace and others have nothing to worry about. Even though they share faculty, the School of Medicine isn’t part of the hospital, and Dean Edward Halperin says everything that’s done today will be done after the merger, but not necessarily in the hospital.

“We will provide that service,” said Halperin at a press conference on Wednesday. “Now if, folks, I could tell you, ‘Here is exactly the room that I’m going to show you it’s going to be done’ today, I would do that. The message we wish to convey is we’re aware of this issue.”

Halperin says private merger talks have made it clear that abortions, vasectomies, stem cell research and other services will continue at separate facilities. But there are some procedures that have to be done in hospitals. For example, many women opt to have their tubes tied right after caesarean sections so another potentially-dangerous pregnancy and surgery can be avoided. But the church doesn’t allow it. It’s not clear where this procedure could be done after the merger.

“There’s a very good example of this in Austin, Texas,” says Lois Uttley, the director of Merger Watch, a group that stands against restrictive healthcare consolidations.

Uttley says the most workable solution for a problem like Louisville’s is to create a hospital within a hospital. In Austin, the 5th floor of a recently-merged facility was turned into a women’s center. It handles all childbirth and reproductive issues and is free from the religious directives that cover the rest of the building.

U of L will be given $15 million to upgrade or build facilities to provide controversial services. And while Halperin has hinted that the money could go to an Austin-like solution, it won’t be easy.

“You have to separately employ people to work at a hospital within a hospital. You have to get a separate hospital operating license for it. You have to get separate health insurance,” says Uttley. “There’s a lot of red tape involved, there’s a lot of work in making this happen. Frankly, it would be far more desirable to have the University of Louisville be able to just keep on giving the quality healthcare it has been given to the indigent of Louisville without having to jump through this hoop.”

“Mergers typically accomplish some sort of economies of scale and allow you to cut costs,” says Attorney General Jack Conway. “So for the university to say ‘we’re going to spend $15 million,’ that raises a lot of additional questions about why they had to come forward with this.”

Conway announced this week that he’s going to look into the merger because of the concerns he’s heard from patients. He can’t stop it, but he can advise the federal regulators who have to give the deal final approval. Conway says he hasn’t made any judgments yet, but he thinks it’s odd that there are so many unanswered questions this far into the merger talks.

“I think they may have been in a rush to announce it,” he says. “I’ve heard from many doctors. They have questions.”

But Conway may not get many answers. At the press conference, Dean Halperin and Vice President of Health Affairs David Dunn gave plenty of assurances that the merger wouldn’t hurt patient care, but they couldn’t cite any specific examples or provide other details. And none of the other parties involved in the merger returned requests for comments for this story.